The UCC SMJ provides students with an opportunity to connect with the greater research community at UCC. This is a platform for students to showcase their work, as well as introduce them to the peer reviewing process. Our goal is to create a space for students to ask critical questions, with the ultimate aim of fostering more well-rounded future healthcare professionals.
UCC Medical Research and Technology Society
We are so pleased to present the Fifth Edition of the Student Medical Journal! Another year's hard work by UCC's medical students is on display, with an impressive array of abstracts, ethical discussion, reviews and original research. This year's special edition focuses on diversity and cultural differences in medicine, interpreted through the unique lenses of UCC's medical societies. This edition also boasts several SMJ firsts, including the publication of conference abstracts from the Royal College of Surgeons in Ireland's Neurovision Conference, as well as UCC's own Student Research Conference! As the SMJ continues to grow, we are always grateful for the dedication and support of our editorial team, our faculty and peer reviewers, and the authors who make these editions possible! Happy reading!
Copyright (c) 2025 Shobha Mehta, Pádraig Cronin https://creativecommons.org/licenses/by-nc/4.0
Reaching the 6-hour target: a comparative analysis of patient characteristics and outcomes in the emergency department
Objectives: Prolonged Emergency Department (ED) visits lead to overcrowding, compromising safe provision of care. To improve patient outcomes, the Emergency Medicine Programme for Ireland set a national target that 95% of ED attendees should be admitted or discharged within 6 hours. This study aims to define the characteristics of patients attending the ED and compare these characteristics for patients whose episode of care was or was not concluded within the 6-hour target. Methods: A cross-sectional study was conducted at Cork University Hospital (CUH), a level one major trauma centre. A total of 2,166 adult patients (aged >= 16 years) were included from the iPatient Manager database. Results: Overall, 50.9% (n = 1,103) of patients had an episode of care lasting less than 6 hours. Over 75s were more likely to stay over 6 hours (n = 300, 68%). The most frequent presenting complaints were ‘limb problems’ (n = 218, 69%) under 6 hours and ‘shortness of breath’ (n = 73, 66%) over 6 hours. Most episodes of care concluded under 6 hours for self referrals and over 6 hours for 999 calls and GP referrals. Triage categories 1, 4 or 5 were more likely to stay in ED under 6 hours. Admitted patients were more likely to stay in ED over 6 hours (n = 606, 74%). Conclusion: This study suggests national targets are not being met, indicating the need for better streamlined outpatient services and further resourcing for urgent care service planning and provision in the future.
Copyright (c) 2025 Kelsey Timoney https://creativecommons.org/licenses/by-nc/4.0
Hyperlipidaemia in primary care: management challenges for GPs and patients
Objectives: This project aims to assess the management of patients with hyperlipidaemia in a General Practitioner (GP) setting. The project will evaluate current care practices, identify gaps in care, and explore barriers to delivering patient care. Methods: This was a cross-sectional study involving a retrospective review of patient data and an interview with the clinic GPs. The project was conducted at Woodview Family Doctors clinic, in Glanmire, Co. Cork, Ireland. The study included 70 patients aged 50-55 years with a diagnosis of hyperlipidaemia, identified through elevated lipid panel results (LDL-C >= 4 mmol/L). Participants were randomly selected from the patient lists of seven GPs at the clinic, 10 patients each. The study primarily assessed patient health and care as determined by relevant factors including total cholesterol, LDL-C, HDL-C, triglycerides, smoking and drinking status, BMI, adverse cardiovascular events, and referral to dietician or cardiologist. Secondary outcomes explored via interviewing the clinic GPs were barriers to delivering optimal patient care. Results: The baseline data was assessed in regard to the number of patients with Max LDL > 2.6 mmol/L, Max Chol > 5.17 mmol/L, and BMI > 25, which were present in over 27% of males and females. All other risk factors were found to be present or above advisable levels in less than 27%. The interview with GPs also revealed significant barriers to effective hyperlipidaemia management, including limited consultation time, patient non-compliance, and resource constraints. A review of literature showed that statin therapy was questionable in efficacy. Conclusion: This study highlighted substantial challenges in managing hyperlipidaemia in a GP setting. Despite adherence to guidelines, practical barriers hinder optimal care. Future initiatives should focus on addressing these barriers through targeted and personalized interventions and measuring long-term outcomes through follow-up
Copyright (c) 2025 Jagatjit Garha, Diarmuid Quinlan https://creativecommons.org/licenses/by-nc/4.0
Immunosuppression, a double-edged sword: sepsis, skin cancer risk, and potential Multiple Sclerosis stabilization
Background: Immunosuppression remains an essential component in post-transplant care but carries significant risks, including infection and malignancy. However, post-transplant immunosuppressants may have a role in stabilising multiple sclerosis (MS), despite not being first-line therapy. Case Presentation: A 65-year-old female with a history of autosomal dominant polycystic kidney disease and associated polycystic liver disease underwent a deceased-donor renal transplant in 1998. Her long-term maintenance immunosuppressive regimen included tacrolimus, low-dose prednisolone, and azathioprine (discontinued in 2024). She was diagnosed with MS in 1990. In July 2024, she was hospitalised for sepsis, with an enhancing hepatic cyst being the presumed source. Blood cultures grew Enterococcus faecium, which was treated with IV vancomycin. This occured on the background of recurrent gram-negative bacteraemias and non-melanoma skin cancers since 2020. These complications were attributed to long-term immunosuppression. Nonetheless, her MS has remained clinically stable for over 20 years. She reported no relapses or neurological deficits, and an MRI in September 2024 showed no new demyelinating lesions. Discussion: This case highlights the double-edged nature of immunosuppressive therapy. While tacrolimus and azathioprine are associated with increased risk of infections and malignancies, particularly skin cancers, they may also modulate autoimmune neuroinflammation. Although evidence for tacrolimus use in MS treatment remains limited, some studies suggest possible neuroprotective effects. Conversely, while azathioprine has shown potential benefits in relapse reduction in controlled trials, further research is needed to establish its full utility in MS management. Short-term high-dose prednisolone is effective in acute exacerbations but lacks evidence for long-term MS stabilisation. Conclusion: This is a unique case of long-term immunosuppressants resulting in recurrent severe infections and malignancies, yet coinciding with sustained MS stabilisation. This raises the hypothesis that certain non-first-line agents may contribute to MS modulation, warranting further investigation.
Copyright (c) 2025 Mihika Mull, Ileesha Singh https://creativecommons.org/licenses/by-nc/4.0
When STEMI isn’t STEMI: a case of severe aortic stenosis masquerading as Acute Coronary Syndrome
Background: Aortic stenosis (AS) is a progressive valvular heart disease that, in severe cases, can present with angina, syncope, and heart failure. Severe aortic stenosis can mimic acute coronary syndromes but rarely presents with ST-elevation myocardial infarction (STEMI)-like features, which presents a diagnostic challenge. This case emphasizes the importance of considering valvular pathology in patients with ischemic ECG changes and non-obstructive coronary arteries. Case Presentation: We describe a 69-year-old female who presented to the emergency department (ED) with acute chest pain, progressive dyspnea, and transient loss of consciousness episodes. Her medical history included Type II diabetes mellitus, hypertension, hypercholesterolemia, and a history of smoking. Initial electrocardiography (ECG) revealed ST-elevation in leads V2-V5, prompting concern for anterior STEMI. However, a coronary angiogram showed non-obstructive coronary disease, and bedside transthoracic echocardiography confirmed the presence of severe AS. Investigations & Diagnosis: The patient’s physical examination findings included an S4 gallop, a grade III-IV harsh systolic ejection murmur radiating to the base, and bibasilar crackles. Laboratory investigations revealed an elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) level of 290 pg/mL, with otherwise normal blood counts and urinalysis. Echocardiographic Doppler imaging demonstrated heavily calcified aortic valve leaflets, ventricular hypertrophy, increased left atrial volume, and elevated right-sided pressures consistent with critical AS. Management & Outcomes: The patient was initially managed for a STEMI with dual antiplatelet therapy before echocardiographic findings led to a shift in diagnosis and management thereafter. Once severe AS was identified, an intra-aortic balloon pump was inserted, which resulted in rapid disease improvement. She subsequently underwent aortic valve replacement (AVR), and was symptom-free at 8 weeks. DISCUSSION & Conclusion: This case underscores the importance of considering AS as a differential diagnosis in patients presenting with STEMI-like ECG findings, particularly in those without significant coronary artery disease. Echocardiography is pivotal in distinguishing AS from myocardial infarction, preventing unnecessary thrombolysis or percutaneous interventions. The definitive treatment for severe AS remains AVR, either via surgical or transcatheter approaches. Clinicians should maintain a high index of suspicion for valvular heart disease in atypical STEMI presentations to ensure timely and appropriate intervention.
Copyright (c) 2025 Nooralhuda Alshami , Zaineb Hamza https://creativecommons.org/licenses/by-nc/4.0
Management of neonatal abdominal immature teratoma in a resource-limited South African hospital: a case report
Introduction: Abdominal immature teratomas, rare congenital tumors, primarily originate from the gonads but can also present in extragonadal locations. Typically identified prenatally, these tumors carry a high risk of in-utero complications, often leading to fetal demise. This case report details the successful management of an abdominal immature teratoma in a neonate at a resource-limited hospital in South Africa, highlighting unique treatment adaptations for such complex cases in low-resource settings. Methods: A 28-day-old neonate with abdominal distention underwent initial imaging, revealing a heterogeneous mass in the left retroperitoneum. Following a multidisciplinary evaluation, the patient was initially managed with chemotherapy based on a differential diagnosis including neuroblastoma. However, a biopsy confirmed an immature teratoma, necessitating a shift in management to surgical resection. The neonate underwent a left nephrectomy and excision of the tumor, followed by postoperative intensive care to address complications from both chemotherapy and surgery. Results: The patient faced significant challenges, including nosocomial infections, neutropenic sepsis, and respiratory issues requiring prolonged ventilation. Despite these obstacles, the tumor was successfully excised, and postoperative complications were managed with targeted therapies, including antibiotic and antifungal treatments, blood transfusions, and hemodynamic support. The patient’s condition stabilized postoperatively, and she is currently stable. Conclusion: This case demonstrates the feasibility of managing complex congenital tumors like abdominal immature teratomas in resource-limited settings. Multidisciplinary collaboration and flexible treatment protocols were essential to achieving a positive outcome. The case offers valuable insights into adaptable management strategies that may be applied in similar cases within low-resource environments, expanding the understanding of congenital tumor care in underserved regions.
Copyright (c) 2025 Sten Kajitani, Anna Feore, Tyaag Desai , Keston Kajitani, Daniel Hall, Mahomed Hoosen Sheik Gafoor https://creativecommons.org/licenses/by-nc/4.0
Research on antibiotic-producing bacteria in Irish soil
For the past decade, the School of Microbiology of University College Cork has conducted an annual project with Antibiotics Unearthed, which aims to isolate and study antibiotic-producing bacteria from soil environments. The Small World Initiative and Tiny Earth Project were established globally in 2015 to encourage biologists and STEM students to participate in active research against infectious diseases and aid in antibiotic discovery. Both programs aim to integrate student learning into fields of research that address the crisis of dwindling supply of antibiotics. The Microbiology society within the EU established Antibiotics Unearthed, inspired by Small World Initiative, to provide training and support in order to continue this important research and raise awareness about AMR. This project was conducted over the course of 6-8 weeks of research at a third-year undergraduate level. This poster presents data from 3 out of over 40 students on a small-scale research project.
Copyright (c) 2025 Jone Martinez, June Naravaite, Conor Shanahan https://creativecommons.org/licenses/by-nc/4.0
Generative AI’s performance on emergency medicine boards questions: an observational study
Background: The evolving field of medicine has introduced ChatGPT as a potential assistive platform, though its use in medical board exam preparation remains debated [1-2]. This study aimed to evaluate the performance of a custom-modified version of ChatGPT-4, tailored with emergency medicine board exam preparatory materials (Anki deck), compared to its default version and previous iteration (3.5) [3]. The goal was to assess the accuracy of ChatGPT-4 answering board- style questions and its suitability as a tool for medical education. Methods: A comparative analysis was conducted using a random selection of 598 questions from the Rosh In-Training Exam Question Bank [4]. The subjects of the study included three versions of ChatGPT: the Default, a Custom, and ChatGPT-3.5. Accuracy, response length, medical discipline subgroups, and underlying causes of error were analyzed. Results: Custom ChatGPT-4 did not significantly improve accuracy over Default (p>0.05), but both significantly outperformed ChatGPT-3.5 (p<0.05) (Table 1). Default produced longer responses than Custom (p<0.05). Subgroup analysis showed no significant difference across medical sub-disciplines (p>0.05). ChatGPT-4 had a 99% probability of passing, while ChatGPT-3.5 had 85%. Conclusions: The findings suggest that while newer versions of ChatGPT exhibit improved performance in emergency medicine board exam preparation, specific enhancements do not significantly impact accuracy. The study highlights the potential of ChatGPT-4 as a tool for medical education, capable of providing accurate support across a wide range of topics in emergency medicine.
Copyright (c) 2025 Sten Kajitani, Mila Pastrak, Anthony Goodings, Audrey Nguyen, Austin Drewek, Andrew Lafree, Adrian Murphy https://creativecommons.org/licenses/by-nc/4.0
Impact of opioid-free anaesthesia on postoperative opioid consumption: a systematic review and meta-analysis
Background: The main objective was to assess the effects of opioid-free versus opioid-based anaesthesia on postoperative opioid use. Methods: A systematic review and meta-analysis were conducted using MEDLINE, SCOPUS, Cochrane Library, Web of Science, and Embase. Inclusion criteria consisted of randomised control trials published from 2004–2024 on adult surgical patients undergoing opioid-free or opioid-based general anaesthesia. Studies with regional anaesthesia, ICU, or pregnant patients were excluded. The primary outcome measure was postoperative opioid consumption at 24 hours. Subgroup analysis was performed on studies measuring the postoperative period as 1-3 hours, 12 hours, 24 hours, and 48 hours. Secondary outcome measures were postoperative nausea and vomiting, Post-Anaesthesia Care Unit discharge time, and pain scores. The Cochrane Risk of Bias (RoB-2) tool assessed the risk of bias, and a meta-analysis was performed using Cochrane RevMan software. Results: The search included 26 RCTs with 2,370 patients undergoing various surgeries, predominantly gastric bypasses, and cholecystectomies. The patients varied in age, BMI, and ASA grade. Opioid-free anaesthesia was associated with a decrease of 11.55 [18.91, 4.20] mg oral morphine equivalents postoperatively. There was also a statistically significant decrease in postoperative nausea and vomiting (RR=0.62 [0.55, 0.71]), and pain scores (0.49 [0.83, 0.15]) in the opioid free anaesthesia group. PACU discharge time was slightly longer in the opioid free group (5.32 [0.11, 10.53] minutes). Discussion: Our systematic review and meta-analysis found a decrease in postoperative opioid consumption in those receiving opioid-free anaesthesia versus opioid-based anaesthesia. We also found that opioid-free anaesthesia can decrease postoperative nausea and vomiting and pain scores. These findings suggest that opioid-free anaesthesia can improve patient outcomes. Limitations include variability in opioids between studies, extrapolated dosage conversions, and non-opioid analgesic use. High heterogeneity across analyses reflects these differences.
Copyright (c) 2025 Hannah Anderson, Noor Alshami, Anahita Azadian, Gabrielle Iohom https://creativecommons.org/licenses/by-nc/4.0
Melatonin as a reactive treatment for post-operative delirium in patients in the cardiac ICU: a retrospective cohort study
Introduction: ICU delirium is a significant problem in post-operative cardiothoracic patients, contributing to prolonged ICU and hospital stays and increased mortality. Current pharmacological treatments, such as benzodiazepines and antipsychotics, have notable adverse effects, leading to interest in safer alternatives. A systematic review has shown melatonin’s effectiveness as a prophylactic agent for delirium in surgical and ICU patients. This study aims to assess the use of melatonin as a reactive therapeutic agent in post-operative delirium in cardiac ICU patients. Methods: This retrospective cohort study analysed data from 127 patients diagnosed with delirium, confirmed through a positive CAM-ICU score. Patients were divided into two groups: one that received melatonin (n=57) as part of their delirium management and another that did not (n=70). The primary outcome was delirium regression, measured by a negative CAM-ICU score during the ICU stay. Secondary outcomes included ICU length of stay, hospital length of stay, and duration of mechanical ventilation. Statistical analyses included the Mann-Whitney U test for continuous variables, the Chi-square test for categorical variables, and binomial regression analysis to determine predictors of delirium regression. Results: Delirium regression was slightly lower in the non-melatonin group (23/57, 32.9%) compared to the melatonin group (24/70, 42.1%), though this difference was not statistically significant (p=0.356). Binomial regression revealed an odds ratio of 0.845 (95% CI: 0.329-2.172, p=0.727) for melatonin’s effect on delirium regression. Statistically significant predictors of delirium regression included ICU length of stay (1.126, 95% CI: 1.041-1.219, p=0.003) and mechanical ventilation (0.897, 95% CI: 0.833-0.965, p=0.004). Conclusion: Melatonin showed a loose association with delirium regression but did not demonstrate significant effectiveness as a reactive treatment for post-operative delirium in cardiac ICU patients. Larger studies with more controlled environments are needed to better assess its potential as a treatment for ICU delirium.
Copyright (c) 2025 Andres Clarke, John Hinchion https://creativecommons.org/licenses/by-nc/4.0
Proton Pump Inhibitors as chemoprophylaxis against the progression of Barrett’s Esophagus: a literature review
Background: Barrett’s Esophagus (BE) is a premalignant condition with a strong association with an increased risk of Esophageal Adenocarcinoma (EAC). Due to this established progression, management strategies focus on symptom control with acid suppression therapy via proton pump inhibitors (PPIs), and endoscopic surveillance using advanced imaging techniques to detect neoplastic progression early, despite its small association with decreased mortality. These approaches emphasize early detection rather than preventing malignant transformation. A case described in The New England Journal of Medicine highlights a 56-year-old obese man with a 4-cm segment of non-dysplastic BE who was managed with PPIs for reflux control and endoscopic surveillance. This case exemplifies a key gap in standard clinical practice - BE management relies on PPIs and surveillance rather than chemoprevention. Given this, optimizing PPI dosage as a targeted pharmacological intervention could offer a minimally invasive alternative to more resource-intensive endoscopic interventions, reducing procedural burden on healthcare systems. However, the role of PPIs in chemoprophylaxis remains unclear, necessitating further investigation into their efficacy in preventing neoplastic progression. Objectives: Evaluate the efficacy of PPIs as a chemopreventive strategy by establishing the optimal dosage and duration required and assess whether PPIs, either alone or in combination with other pharmacological agents will effectively interrupt the progression of BEs from high-grade dysplasia to EAC. Methods: To address this gap, a systematic search was performed using PubMed with MeSH terms. Exclusion and inclusion filters were applied, yielding 49 articles. Studies focusing on PPI use alone or with other pharmacological agents were prioritised with title/abstract screening conducted to assess eligibility. This generated the 14 articles used in this review. Results: The literature review found strong evidence supporting the chemopreventive role of PPIs in the neoplastic progression of Barrett’s esophagus (BE). Long-term PPI use has been shown to reduce the risk of high-grade dysplasia and esophageal adenocarcinoma (EAC), with some studies even demonstrating a significant reduction in all-cause mortality and neoplastic progression in BE patients. The greatest benefit was observed at higher PPI doses, and this was further enhanced combined with NSAIDs or statins, suggesting potential synergistic chemopreventive properties. Despite these promising findings, variability in individual patient responses, coupled with concerns regarding the long term risk of PPI therapy, has fueled ongoing debate about the safety and efficacy of prolonged use. This confers the need for a tailored, individualized approach to BE chemoprophylaxis strategies. These findings highlight the necessity for updated clinical guidelines to optimize PPI dosing, treatment duration and potential adjunctive therapies in the prevention of BE progression. Conclusion: The available evidence suggests that while long-term, high-dose PPI therapy may be an effective chemopreventive strategy, its ability to completely prevent neoplastic progression remains uncertain. Future research should focus on determining the optimal PPI dosage, duration, and potential synergistic effects with other chemopreventive agents. Simultaneously, standardizing these approaches through refined treatment protocols could improve clinical practice and help reduce the burden of EAC.
Copyright (c) 2025 Touqa Abdelsamad, Ally O’Brien Davis https://creativecommons.org/licenses/by-nc/4.0
Ramsay Hunt Syndrome misdiagnosed as Bell’s Palsy: a case report
Introduction: Ramsay Hunt Syndrome (RHS) is a neurological disorder caused by the reactivation of latent varicella-zoster virus in the facial nerve. It often presents with ipsilateral facial palsy, otalgia, and vesicular eruptions. RHS is often misdiagnosed as Bell’s palsy, which results in delayed treatment and increases the risk of long-term complications. This case highlights a 38-year-old male initially diagnosed with Bell’s palsy whose symptoms persisted despite standard therapy. He later developed ear pain, discharge, vesicles, and gait instability, prompting a revised diagnosis of RHS. Methods: A comprehensive clinical assessment was conducted, including a detailed patient history, neurological and otologic examination, and laboratory investigations. Diagnostic imaging and serological tests confirmed varicella-zoster virus reactivation. The patient was treated with antiviral therapy (acyclovir), corticosteroids, and symptomatic pain management. Results: The patient initially presented with progressive facial nerve dysfunction refractory to Bell’s palsy treatment, and subsequently developed vesicular ear lesions and balance disturbances. Examination revealed asymmetric facial weakness, inflamed auricular vesicles, and an unsteady gait. Laboratory results confirmed RHS. Following initiation of antiviral and steroid therapy, symptoms improved, though residual facial weakness persisted. Conclusion: This case underscores the importance of early diagnosis of RHS in order to prevent long term complications. When diagnosing idiopathic Bell’s palsy, RHS should be considered, particularly when new otologic symptoms emerge. Unlike Bell’s palsy, RHS is associated with a lower rate of full recovery due to greater nerve degeneration. Clinicians should maintain a high index of suspicion for RHS in cases of persistent facial palsy, ensuring timely diagnosis and intervention in order to improve patient outcomes.
Copyright (c) 2025 Houssein Chahrour, Madeleine Smee, Anahita Azadian, Manvir Duhra, Nav Jalan https://creativecommons.org/licenses/by-nc/4.0
A re-audit of polypharmacy recognition in older patients on admission to an acute hospital
Background: Polypharmacy has a high overall prevalence of approximately 37%. Left unrecognised, polypharmacy can increase the risk of drug-drug interactions and lead to prescribing cascades. Prompt recognition and management of polypharmacy is essential as it may represent a reversible cause of a patient’s symptoms. Methods: A re-audit of polypharmacy recognition in Bantry General Hospital was performed. Patients were included if they were aged seventy-five years or older, prescribed 5 or more medications on admission and were in-patients during a 24-hour period on the 10th of September 2024. The presence or absence of polypharmacy as a diagnosis was recorded. Results: 25 patients were identified as eligible for inclusion. 17 male patients (68%) and 8 female (32%) were included. The median age was 82 years old and ages ranged from 75-99. Polypharmacy was included as a diagnosis in only one of the 25 patients’ admissions (4%), this is a marginal increase from 0 (0%) in the previous audit. The mean number of medications observed was 8.76 (2.7% less than the previous audit). The number of medications prescribed ranged from 5 – 15. The maximum number of prescribed medications reduced from 21 to 15 in the re-audit. Conclusion: Marginal improvements in the volume of polypharmacy and polypharmacy documentation were observed in this re-audit, however, further efforts are required to reduce this problem. It is important to recognise and document polypharmacy in older patients to reduce the potential for adverse outcomes.
Copyright (c) 2025 Matthew Cronin, Ivanna McMahon, Ahmed Ibrahim, Nurul Azizan, Rizwan Aziz https://creativecommons.org/licenses/by-nc/4.0
A case study on suboptimal asthma control in a pediatric patient: addressing adherence and caregiver concerns
This case study presents an 8-year-old male patient, B.M., admitted to Cork University Hospital with symptoms of cough, wheezing, shortness of breath, and fever (38.5°C). With a history of recurrent asthma exacerbations requiring hospitalization, B.M. has suboptimal asthma control due to poor adherence to inhaled corticosteroids, primarily driven by parental concerns about potential side effects, such as growth stunting. His exacerbations are primarily triggered by viral infections, with recent exposure to a family member with a viral illness. Clinical examination revealed wheezing on expiration, prolonged expiration, and stable vital signs, suggesting a mild to moderate exacerbation. The literature review highlights asthma as a prevalent pediatric condition, influenced by genetic, environmental, and immunological factors. Although not curable, the symptoms of asthma can be well controlled with effective treatment. However, as present in the case, adherence to asthma treatment remains a significant challenge, with one study reporting mean adherence rates as low as 36% to ICS in children –thus hindering the treatment effectiveness. Poor health literacy and side effect anxiety are two reasons for the poor adherence relevant to this case. To tackle unique difficulties in adhering, the case emphasizes the importance of personalized asthma action plans (PAAPs), which are individualized plans catered to the patients needs/concern. Studies have shown that increased patient involvement in decision making regarding their health results in an increase in the effectiveness of care. It can be discussed with the patient’s caregiver that although some research suggests that ICS may temporarily slightly impact growth, the benefits in preventing severe exacerbations outweigh these risks. This case emphasizes the importance for patient/caregiver engagement, healthcare literacy and tailored treatment plans to optimize asthma management in pediatric populations and prevent long-term consequences.
Copyright (c) 2025 Manvir Duhra, Houssein Chahrour, Anahita Azaidan, Carina Lam https://creativecommons.org/licenses/by-nc/4.0
Lithium-induced cardiotoxicity mimicking Acute Coronary Syndrome: a case report
Introduction: Lithium toxicity, a complication of chronic lithium therapy used in the treatment of bipolar disorder (BPD), commonly presents with gastrointestinal and neurological symptoms. However, rare cardiac manifestations of lithium cardiotoxicity can occur. This case describes a 51-year-old woman with BPD on long-term lithium therapy who developed neurological symptoms (confusion, resting tremor, dysarthria). Investigations were notable for elevated troponin levels and transthoracic echocardiogram revealed a novel reduced left ventricular ejection fraction. Coronary artery disease and other potential causes were ruled out, and lithium-induced cardiotoxicity was determined to be the etiology of the patient’s presentation. Methods: A thorough clinical evaluation was conducted, including history, physical examination, and diagnostic testing. Investigations included an electrocardiogram (ECG), transthoracic echocardiogram (TTE), coronary angiography, chest X-ray, neuroimaging (CT and MRI brain), and blood tests (troponins, lithium levels, thyroid panel). The patient declined a CT angiogram of the head, leading to an alternative MRI assessment. Results: The patient presented to the emergency department with confusion, bilateral resting tremors, gait instability, and dysarthria. Non-contrast CT and MRI of the head ruled out hemorrhagic and ischemic stroke, respectively. Chest X-ray confirmed mild pulmonary congestion. ECG showed bradycardia with 1st-degree atrioventricular block and TTE revealed global systolic dysfunction with a reduced ejection fraction 35-40%. Laboratory findings indicated elevated high sensitivity troponin I of 105 ng/L. Coronary angiography showed no evidence of significant coronary artery disease. Lithium levels were elevated at 3.3mmol/L on admission. The patient remained conscious and interactive, with no indications for emergent hemodialysis. This resulted in the diagnosis of acute-on-chronic lithium neuro- and cardiotoxicity. Cardiac function improved with standard lithium toxicity management, including lithium cessation, IV hydration, and monitoring. Conclusion: This case describes lithium-induced cardiotoxicity, a rare yet critical differential diagnosis in patients with suspected coronary artery syndrome in the context of lithium treatment. Unlike ischemic cardiac disease, it presents with global rather than regional myocardial dysfunction. Early recognition and lithium cessation are essential for management.
Copyright (c) 2025 Anahita Azadian, Houssein Chahrour https://creativecommons.org/licenses/by-nc/4.0
A rare cause of otalgia - Langerhans Cell Histiocytosis case report
Background: Langerhans Cell Histiocytosis (LCH) is a myeloid neoplastic disorder with a rare prevalence of one case per million adults. LCH has a complicated etiology that presents as lesions composed of proliferative ‘LCH cells’. These lesions can affect different organ systems including the lungs, skin, liver, and bone. This study reports the steps toward LCH diagnosis in an adult, the current state of literature in regards to LCH of the temporal bone, and important takeaways for ENT physicians. Case Report: We describe the case of a 52 year old woman with a two year history of seemingly idiopathic Central Diabetes Insipidus (CDI) complaining of right otalgia for two weeks unresponsive to antibiotic therapy. The patient has a normal otoscopy and audiogram, and an elevated CRP test (22 mg/dl). Further investigations with CT and MRI confirmed destruction of the right mastoid air cells and enhancing tissue respectively. Cholesteatoma was ruled out with diffusion weighted imaging on MRI. Cortical mastoidectomy was performed and histopathological examination of biopsy confirmed the diagnosis of LCH. The patient has a final multisystem (Temporal bone and Pituitary gland) low-risk LCH diagnosis with a great prognosis through chemotherapy and corticosteroid treatment. Conclusion: Temporal bone and craniofacial manifestations of LCH are often managed by ENT physicians. A plethora of pathologies present with otalgia in ENT practice, but symptoms such as CDI and otalgia with lack of findings on otoscopy should raise suspicion for LCH.
Copyright (c) 2025 Ahmad Albakri, Claudine Murphy, Sebastian McWilliams, Eadoin O’Cathain https://creativecommons.org/licenses/by-nc/4.0
Differences between the clinical manifestation of adult-onset and childhood-onset Systemic Lupus Erythematosus
Introduction: Systemic lupus erythematosus is a multi-system autoimmune disorder that affects approximately 1500 people in Ireland. The cause of SLE is multifactorial and involves genetic, environmental, and hormonal influences. Most commonly diagnosed in women (10:1) and between ages 15–44, international studies have shown differences between childhood-onset SLE (COS) and adult-onset SLE (AOS), however, no such research exists in Ireland. Methods: This retrospective cohort study analysed patient records from Cork University Hospital’s (CUH) Rheumatology Department (November 2023-June 2024). A convenience sampling method was used, and eligible participants were identified from the hospital database of referral letters. Categorical variables of symptoms and autoantibodies were analysed using Fisher’s exact test and logistic regression for significant findings. Results: A total of 71 patients (COS = 24, AOS = 47) were included in this study. The mean age at diagnosis was 28.01 ± 11.57 years. Malar rash was significantly more common in COS (17, 70.8%) compared to AOS (17, 36.2%). Polyarthritis/polyarthralgia was significantly more prevalent in AOS (43, 91.5%) than in COS (7, 70.8%). While autoantibody profiles revealed no significant differences, low complement C4 levels were significantly more prevalent in COS (16, 66.7%) compared to AOS (15, 31.9%). Finally, Lupus Nephritis, while also insignificant, was also more prevalent in COS (11, 45.8% vs 17, 35.2%). Conclusion: The higher prevalence of malar rash and complement deficiency in COS suggests a more pronounced immune response in younger patients. Although statistically insignificant, trends such as higher fever incidence increased lupus nephritis rates in COS highlight areas for further research. These findings increase the understanding of SLE in Ireland and underscore the importance of age-specific considerations in diagnosis and management. Future multicenter collaboration could offer deeper insights into regional variations and help refine treatment approaches.
Copyright (c) 2025 Rithvik Karthikeyan, Grainne Murphy https://creativecommons.org/licenses/by-nc/4.0
Understanding the impact of palliative and ablative radiotherapy (RT) on Health-Related Quality of Life (HRQOL) in patients with metastatic disease
Background: Radiotherapy (RT) is an effective but underutilized treatment option for patients with metastatic cancer. While studies have examined RT’s impact on health-related quality of life (HRQOL) internationally, there is limited data on Irish patients. Some research suggests aspects of quality of life may dip after RT but eventually return to baseline, though this varies depending on prognosis. Since healthcare systems, cultural factors, and socioeconomic conditions differ across countries, these findings may not be easily generalizable to the Irish population. This study aims to explore the feasibility of the use of electronic patient-reported outcomes (ePROs) to assess HRQOL in Irish patients receiving palliative or ablative RT. Methods: This single-institution observational study at Cork University Hospital utilizes the ePRO application, ONCOpatient, to administer pre-validated HRQOL questionnaires including the EORTC-QOL-C30, EORTC-QOL-C15 PAL, and EQ-5D-5L to patients or their caregivers via their smartphone at four-timepoints: baseline, final treatment, and 4- and 12-weeks-post-treatment. Descriptive statistics were used to summarize engagement and compliance. Longitudinal analysis will be conducted to evaluate HRQOL changes over time, and regression models will be used to identify predictors of HRQOL outcomes. Results: From October 2024 to March 2025, 22 participants were onboarded (mean age 63.23 years, 40.9% male, 59.1% female), with various cancer subtypes (breast n=7, lung n=5, renal n=3, other n=7). Overall app engagement was 54.5% (9/14 patients and 3/8 caregivers). Compliance declined over time: 40.9% at baseline, 25% at final treatment, 15% at 4-weeks post-RT, and 0% at 12-weeks post-RT. Barriers to app engagement included licensing issues, syncing delays and difficulty locating assessment dates. Limited provider engagement regarding patient identification and onboarding also presented challenges. Further results to follow. Conclusion: This study highlights feasibility challenges in integrating ePROs for metastatic cancer patients receiving RT. While engagement was moderate, declining compliance indicates barriers to data collection. Addressing technical and app usability issues may improve long-term implementation. Future analyses will further assess HRQOL changes over time and identify predictors of patient-reported outcomes to enhance RT decision-making and patient-centered care.
Copyright (c) 2025 Kimya Ghaffarian, Bojan Macanovic, Micheal O’Cathail, Seamus O’Reilly, Orla Monaghan, Karen O’Meara, Eoin O’Carroll, Aisling Barry https://creativecommons.org/licenses/by-nc/4.0
Hypertensive disorders in pregnancy and cognitive outcomes in childhood and adolescence
Background: Hypertensive disorders in pregnancy (HDP), including preeclampsia, have been linked to lower cognitive scores in offspring, but findings remain inconsistent. This study examines the relationship between maternal HDP and cognitive development in offspring aged 3–17 years. Methods: We conducted a cohort study using data from the UK Millennium Cohort Study (2001). Maternal HDP was examined as an exposure factor in relation to children’s cognitive abilities, including verbal and visuospatial outcomes. Cognitive delay was defined as scoring >1 SD below the mean and classified as “never delayed,” “delayed only once,” “persistent delay,” “early childhood delay,” or “adolescent onset delay.” Results: Among 5,994 singleton pregnancies, 460 were affected by maternal HDP. Mothers were primarily aged 30–39 years (51.6%) and predominantly Caucasian (86.2%). Adjusted odds ratios (OR) controlled for maternal characteristics (age, ethnicity, BMI, alcohol use, smoking, education, income) and offspring gender. No significant association was found between maternal HDP and verbal delay at 3 years (OR: 1.008, 95% CI: 0.783–1.297), 5 years (OR: 0.864, 95% CI: 0.659–1.133), or 7 years (OR: 1.034, 95% CI: 0.800–1.336). Similarly, visuospatial delay at 7 years (OR: 0.863, 95% CI: 0.679–1.097) and adolescence (14 years: OR: 0.871, 95% CI: 0.688–1.101; 17 years: OR: 1.069, 95% CI: 0.856–1.336) showed no significant association. Conclusion: Maternal HDP does not appear to significantly impact offspring cognitive development. Further research with larger cohorts is needed.
Copyright (c) 2025 T Das, As Khashan , M Hanrahan https://creativecommons.org/licenses/by-nc/4.0
Predictive markers for treatment response in metastatic KRASmutant non-small cell lung cancer
Background: Non-small-cell lung carcinoma (NSCLC) represents 85% of all lung cancer cases, with Kirsten Rat Sarcoma Virus (KRAS) being the most commonly detected mutation. This study retrospectively reviews patient charts and databases to identify specific markers linked to favorable and poor responses to treatment in a tertiary care setting. Methods: Pre-treatment hematological, pathological, and biochemical data were gathered from 70 patients diagnosed with KRAS-mutant NSCLC at Cork University Hospital between January 1, 2017, and December 31, 2021. Patients were categorized by radiological response to treatment and progression-free survival (PFS). Statistical analysis was performed using SPSS v29, with parametric data expressed as mean (SD) and nonparametric data as median [IQR]. T-tests, Chi-squared tests, and Mann-Whitney U tests were employed, with a significance level of p <0.05. Results: The average age of patients was 66 years (10.2), with an age range of 36-86 years. The median PFS was 36 weeks [74.5], and overall survival (OS) was 55.6 weeks [88.3]. Patients with progressive disease (PD) had higher levels of neutrophils (p = 0.015), neutrophil-to-lymphocyte ratio (NLR) (p = 0.04), and platelet-to-lymphocyte ratio (PLR) (p = 0.026) compared to those with partial response (PR) to treatment. Patients with poor PFS showed increased platelet counts (p = 0.047, 95% CI [-112.3, -0.796]), NLR (p = 0.001), and PLR (p = 0.004), as well as reduced serum albumin (p = 0.022, 95% CI [1.06, 13.25]) and lymphocytes (p = 0.010, 95% CI [0.121, 0.879]) in comparison to those with good PFS. KRAS mutation subtype and tumor pathology had no significant effect on treatment response. Chemotherapy treatment was associated with significantly longer PFS compared to other treatment types (p <0.001). Conclusion: Certain patient-specific biomarkers were associated with poorer radiological response to treatment and reduced PFS. These biomarkers could be useful for clinicians when assessing treatment plans and for prognostication of these patients.
Copyright (c) 2025 Emily Ryan, Dearbhaile Collins https://creativecommons.org/licenses/by-nc/4.0
Amusement park rides and cardiac devices: heart dropper or device stopper?
Background: Cardiac implantable electronic devices (CIEDs) are essential for managing cardiac conditions, but may malfunction due to magnetic fields >10,000mG. Roller coasters using linear induction motors (LIMs) generate magnetic fields, yet their potential for electromagnetic interference (EMI) with CIEDs is unclear. This study assesses magnetic field exposure on amusement rides and examines healthcare provider recommendations. Methods: Magnetic field strength was measured using gaussmeters placed at shoulder and abdomen levels, representing pediatric CIED sites. Rides at an amusement park were tested at least four times, recording median and maximum magnetic field strengths per second throughout the ride. Magnetic field strengths were compared between rides with health advisory messages (HAMs) and without (NHAMs). A survey was distributed to the Pediatric and Congenital Electrophysiology Society (PACES) and the Canadian Council of Cardiovascular Nurses to assess healthcare provider recommendations. Results: A total of 15 rides were sampled: 11 with HAMs and 4 with NHAM. The median magnetic field strength was higher for HAM rides (2.9mG) than NHAM rides (1.6mG; p=0.05). Maximum field strength was also greater in HAM rides (46.4mG vs. 6.5mG; p<0.001), and in rides using LIMs (n=2) compared to those using other mechanisms (211.7mG vs. 7.8mG; p<0.001). Only 18.1% (n=13) of healthcare providers relied on published resources for amusement park ride recommendations, while 58.3% (n=42) advised patients to consider HAMs. Conclusion: Magnetic field strengths on all rides were clinically insignificant, posing minimal EMI risk for CIED patients. Further validation and standardized guidelines are needed to inform healthcare recommendations for patients with CIEDs.
Copyright (c) 2025 Alexander Johnson, Mia Kassab, Dania Kallas, Sonia Franciosi, Jeffrey Bone, Sakethram Saravu Vijayashankar, Shubhayan Sanatani https://creativecommons.org/licenses/by-nc/4.0
A retelling of the first successful treatment of Total Posterior Craniopagus
Introduction: The case of the first total posterior craniopagus twins in the Central African Republic highlights the complex challenges and remarkable outcomes in paediatric neurosurgery, particularly in resource-limited settings. Objectives: The twins underwent a meticulous separation process at Bambino Gesù Hospital in Rome. A three-step separation was performed in order to construct two independent venous systems—the first part involving the separation of the tent and the first of the two common transverse sinuses. The second surgery scheduled was the separation of the upper sagittal sinuses and the junction point of the cerebral venous sinus, with the use of a neuronavigation. The final operation performed was the separation of the second transverse sinus and its tentorium and the reconstruction of the brain envelope. In total, the three-part surgery was spread over the time frame of 13 months. Conclusion: The results of this surgery reaffirm that early surgical intervention combined with post- operative care and rehabilitation can optimise outcomes for complex congenital conditions. It also emphasises the importance of detailed pre-surgical planning, advanced imaging techniques, and a multidisciplinary approach in achieving a successful separation. Finally, this case underscores the critical role of neuroplasticity in children, where the brain’s remarkable ability to reorganise and adapt facilitates recovery post-surgery. Neuroplasticity was pivotal for the twins’ cognitive and motor development, resulting in a favourable clinical prognosis and quality of life.
Copyright (c) 2025 Aura Ilovan https://creativecommons.org/licenses/by-nc/4.0
A Rasmussen Encephalitis in an adolescent girl
Introduction: A 12-year-old female presented to clinic with various features of cognitive decline, including headaches, worsening academic performance, and decline in writing abilities and social skills. On neurological examination, she was found to have intrinsic muscle weakness in the right hand, reduced grip and wrist extension of the right arm, pronator drift of the right arm, and left hemiglossal atrophy, along with lessened spontaneous speech abilities. She had no dysarthria, sensory loss, or reduction of tone. The differential diagnoses considered for this patient were chronic viral encephalitis and autoimmune encephalitis. Case Report: Initial tests included serology (Full Blood Count and IgG Antibody) and cerebrospinal fluid (CSF) analysis, both of which were unremarkable. Angiography results were also normal. Magnetic Resonance Imaging (MRI) depicted left cerebral hemisphere atrophy and T2 hyperintensity in the frontal lobe. Electrophoresis and flow cytometry were not indicative of oligoclonal bands or NMDA-receptor antibodies. Most interestingly, routine EEG did not demonstrate epileptic activity (the hallmark sign of RE), but right-sided amplitude predominance indicated left hemispheric dysfunction. Surgical intervention involved a biopsy of the anterior middle frontal gyrus. The biopsy depicted CD45+ T-cell lymphocyte infiltration, microglial nodules, cortical atrophy, neuronal loss, and cytomegalic dysplastic neurons, which altogether are indicative of Rasmussen Encephalitis. Conclusion: The patient was started on immunosuppressive therapy, including tacrolimus, methylprednisolone, and Intravenous Immunoglobulin (IVIG). 6-month follow-up demonstrated interval progression of atrophy, and 15-month follow-up demonstrated improvement in right extremity strength. Immunosuppression was continued, and the patient continues to be seizure-free with no further worsening of cognitive abilities
Copyright (c) 2025 Shreya Sankar https://creativecommons.org/licenses/by-nc/4.0
Intracranial Vein of Galen Malformation and its management
Background: Vein of Galen Malformation (VOGM) is a rare congenital arteriovenous malformation affecting the paediatric population, characterized by a fistula between the diencephalon and a dilated vein of Galen. Case Description: This report presents the case of a 6-month-old male infant referred for developmental delays and abnormal head circumference. Clinical examination revealed macrocephaly, dilated scalp veins, and neurological abnormalities. Neuroimaging, including CT, MRI and MRA, confirmed a large VOGM with associated hydrocephalus. Furthermore, an echocardiography revealed a high-flow cardiac murmur, confirming the hemodynamic impact of the VOGM. A multidisciplinary team devised a treatment plan involving a combined transvenous and trans-arterial endovascular embolization method using a “kissing microcatheter technique” and ventriculoperitoneal shunt placement. Postoperative recovery showed improvement in neurodevelopmental milestones and reduced head circumference. VOGM management requires a comprehensive approach, including early diagnosis, precise imaging, and timely intervention. Conclusion: This is a novel case because the interventional radiology speciality approach demonstrates the optimum diagnostic and preplanning investigations for cases of vascular origin. In addition, the kissing microcatheter endovascular embolisation technique highlights the importance of considering this innovative surgical option in complex vascular cases.
trans-arterial endovascular embolization
Paediatric Intracranial Vein of Galen Malformation
Copyright (c) 2025 Jubran Al-balushi https://creativecommons.org/licenses/by-nc/4.0
Visualizing facial distortions In Prospometamorphopsia
Background: Prosopometamorphopsia is a specific type of visual distortion where patients perceive distortions when viewing the faces of others. It is an extremely rare condition, with less than 100 cases being reported since 1904. Not to be confused with prosopagnosia which is a condition in which patients cannot recognize faces, in prosopometamorphopsia patients can still identify faces even while being distorted. The cause of this is unknown, however this case in particular sheds more light on the condition and the potential aetiology behind this condition. Lesions in the posterior section of the corpus callosum, specifically the splenium have been linked to visual distortions (prosopometamorphopsia) and reading difficulties such as alexia. Case Description: This case explores a 62 year old right handed Caucasian male presenting with alexia and prosopometaphoprasia affecting the lower part of the face after suffering an infarction in the left splenium of the corpus collosum. The patient reported distorted perception specifically of people’s mouths while other facial features appeared normal, he also reported difficulty in reading but his writing remained unaffected. The patient’s opthalmic examination revealed normal visual acuity, color vision and ocular motility with no apparent abnormalities on retinal examination. Neuroimaging disclosed a late subacute infarction in the left splenium which is crucial for the interhemispheric transfer of visual information and is a part of the Papez circuit involved in memory function. Conclusion: The findings from this case emphasize the importance of comprehensive neuroimaging in patients who present with unusual combinations of visual and cognitive disturbances.
Copyright (c) 2025 Rhieya Rahul https://creativecommons.org/licenses/by-nc/4.0
Introduction: Meningiomas are arachnoid cell-originating tumours which rarely present in the paediatric population. Characteristic symptoms include focal or generalised seizures, although many patients are asymptomatic. These tumours are commonly seen in patients suffering from neurofibromatosis type 2, and almost half of patients presenting with meningiomas have allele losses in the DAL-1 and NF2 genes. Objectives: To elucidate the demographic and autopsy findings of fatal cases involving NPS in Southern Ireland as compared to deaths involving traditional drugs of abuse (TDOA). Methods: Post-mortem reports from the Cork-Kerry region with positive toxicology for illicit substances between 2012-2016 were retrospectively analyzed to compare NPS and TDOA ases with respect to circumstances surrounding death, toxicological results, and pathological findings. Results: Between 2012-2016, there were 164 cases involving illicit substances in the Cork-Kerry region. NPS accounted for 17 (10.4%) cases, with an average annual mortality rate of 34.8 per 100,000 population. NPS contributed to the cause of death in 70.6% of cases where detected, compared to 43.5% for TDOA only. In both cohorts, fatal abusers were predominantly young males. Importantly, cases involving NPS showed a higher proportion of mono-drug intoxication and presentation to hospital prior to death. Autopsy findings were non-specific but commonly featured pulmonary congestion, aspiration, and cerebral oedema. Conclusions: NPS are detected in a small proportion of medicolegal autopsies but contribute significantly to acute intoxication deaths. This study highlights the need for effective drug monitoring and enforcement strategies, along with improved management of drug toxicities presenting to hospital
Copyright (c) 2025 Judith Esther Linares Gomez https://creativecommons.org/licenses/by-nc/4.0
LTBP2: Bridging our understanding of the extracellular matrix in cardiac fibrosis
Cardiac fibrosis is a major driver of heart failure, with complex mechanisms contributing to its progression. One such contributor is latent transforming growth factor-beta binding protein-2 (LTBP2), a protein significantly upregulated in fibrotic tissues. Unlike other TGF-beta binding proteins, LTBP2 does not bind to TGF-beta, and its role in cardiac fibrosis is largely unexplored. However, LTBP2 is involved in key profibrotic signaling pathways, including those related to TGF-beta1, fibroblast growth factor-2 (FGF-2), caspase-3, and NF-kB, all of which are potential therapeutic targets. Notably, NF-kB signaling activation through LTBP2 in fibrosis progression has been identified as an important mechanism that warrants further investigation. In addition to its role in cell signaling, LTBP2 is essential for maintaining microfibril structural integrity, particularly in tissues such as the eye. However, the specific contributions of LTBP2 and microfibrils to cardiac fibrosis remain to be fully elucidated. Furthermore, LTBP2’s early-stage upregulation and its presence in circulating serum highlight its potential as a biomarker for fibrotic diseases. Studies in pulmonary fibrosis and other organ systems have demonstrated that serum LTBP2 levels correlate with fibrosis progression and the differentiation of fibroblasts to myofibroblasts. These findings suggest that LTBP2 may serve as an early indicator of cardiac fibrosis. Overall, the investigation of LTBP2’s role in cardiac fibrosis is crucial for understanding its therapeutic potential and for identifying new strategies to promote reparative fibrosis and prevent the progression to heart failure.
cardiac fibrosis, LTBP2, ECM, Fibrosis Marker
Copyright (c) 2025 Ahsan Rashid, Scott P. Heximer https://creativecommons.org/licenses/by-nc/4.0
Analgesic efficacy of a single dose intrathecal morphine in patients undergoing robot-assisted laparoscopic prostatectomy (RALP)
Background: The World Federation of Societies of Anaesthesiologists has established guidelines for anaesthesia in laparoscopic surgery, but detailed protocols for perioperative pain management in Robot-Assisted Laparoscopic Prostatectomy (RALP) are lacking (1). This study evaluated the analgesic efficacy of a single intrathecal morphine (ITM) dose in RALP. Methods: Following Ethics Committee approval, a retrospective chart review of 79 patient charts that underwent RALP procedures between 01/01/2021 and 31/05/2023 was conducted. One patient was excluded due to regular codeine use. Patients were divided into ITM (n=18) and non-ITM (NITM, n=60). Outcomes included recovery room pain scores, opioid requirements, time to first opioid request, 24-hour postoperative opioid consumption, opioid-related side effects, and anti-emetic usage. Data was analyzed using SPSS, with P<0.05 considered significant. Results: The median [IQR] ITM dose was 200 [50] micrograms. Pain scores in the RR and 24-hour opioid consumption were similar between groups. However, the ITM group had a longer time to first opioid request compared to the NITM group (16.64 [22.9] vs. 1.32 [7.78] hours, P=0.05). Morphine-related side effects were more frequent in the ITM group (16.7% vs. 0%, P<0.001), as was anti-emetic usage (55.6% vs. 15.3%, P=0.001). Conclusion: In conclusion, a single dose of intrathecal morphine delayed the time to first opioid request in RALP patients but was associated with higher rates of side effects and anti-emetic use. These findings highlight the need to weigh the benefits of analgesia against the potential for increased adverse effects in patients undergoing RALP. References: Iqbal H, Gray M, Gowrie-Mohan S. Anaesthesia for Robot-Assisted urological surgery. Tutorial of the week, 6 Aug 2019. https://resources.wfsahq.org/wp-content/uploads/408_english.pdf (Accessed 13 Jan 2025).
robot-assisted laparoscopic prostatectomy
Robot-assisted laparoscopic prostatectomy
Copyright (c) 2025 Erika Wolff, Gabriella Iohom https://creativecommons.org/licenses/by-nc/4.0
Diversity and cultural differences in preeclampsia beliefs and management practices: a narrative review
Preeclampsia is a hypertensive disorder that poses significant risks to maternal and fetal health. Effective management is critical to minimize maternal and fetal morbidity and mortality. Preeclampsia management practices vary widely across different cultural and geographical settings. This review explores the cultural differences in the beliefs and management of preeclampsia. High income countries benefit from well-established diagnostic and treatment protocols however, low- and middle-income countries face challenges related to lack of knowledge, resources, and access to care. Cultural factors, including the use of traditional medicine and the influence of family decisions on healthcare, often delay receiving appropriate medical care. In some cultures, traditional birth attendants and community health workers are the primary antenatal carers, but their approaches can conflict with modern medical practices. By understanding these cultural influences in healthcare, it can improve maternal health outcomes. This review emphasizes the need for culturally competent healthcare, improved training for healthcare workers, and the implementation of standardized protocols globally. By integrating culturally competent practices into maternal healthcare systems and addressing the structural barriers to care, healthcare providers can optimize the diagnosis, treatment, and long-term outcomes for women with preeclampsia.
Cultural Differences in Preeclampsia Beliefs and Management
Copyright (c) 2025 Aqsa Shoaib https://creativecommons.org/licenses/by-nc/4.0
General anesthesia for a patient with Chronic Obstructive Pulmonary Disorder and postoperative respiratory failure: a case report
Background: Chronic obstructive pulmonary disease (COPD) and other comorbidities, such as obesity and diabetes, significantly increase the risk of postoperative complications, including respiratory failure. This case concerns a 53-year-old male patient (BT) who presented to Cork University Hospital for rigid bronchoscopy for debulking of his carcinoid tumour obstructing the left main bronchus. Upon emergence from anesthesia, the patient (BT) suffered bronchospasm, which progressed into respiratory failure. Methods: The case study methodology involved a comprehensive review of the patient's medical history, family background, and clinical presentation. An evaluation of respiratory complications and contributing risk factors for general anesthesia was done through a thorough review of the literature. Consent was obtained prior to drafting the case report. Results: Postoperatively, the patient developed bronchospasm, leading to respiratory failure. Immediate interventions included the administration of anesthetic agents, Magnesium, and Ventolin. Chest imaging revealed mediastinal widening, atelectasis, and poor inspiratory effort. The patient also experienced gagging and hemoptysis. Discussion: COPD is associated with increased postoperative complications, including prolonged mechanical ventilation. Low preoperative PaO2 is a significant risk factor for postoperative respiratory failure. Additionally, airway hyper-reactivity and bronchospasm can be triggered by pharyngeal and tracheal stimulation during the procedure. Conclusion: Preoperative evaluation of pulmonary risks, particularly in COPD patients, is crucial for identifying potential complications. Anesthesia management, tailored to the patient's unique conditions, plays a key role in reducing perioperative risks and improving outcomes in high-risk cases.
Copyright (c) 2025 Zaineb Hamza https://creativecommons.org/licenses/by-nc/4.0